Ethical Issues Over DNR Orders
Mr. Warden, a 93-year-old white male , is admitted to Centerville Community Hospital from Centerville Estates Nursing Home located in your state. Mr. Warden has had multiple strokes and is only partially responsive to painful stimuli. He does not recognize or respond to nursing staff, physicians, or family members. In addition, he has flexion contractures and a large infected decubitus ulcer over his left sacral area. Further evaluation shows Mr. Warden has extremely poor heart function and is in congestive heart failure. The notes from Centerville Estates Nursing Home indicate Mr. Warden has had one visitor in the past six months; that visitor was not a family member.
As the administrator of this nursing home, you have asked the Warden family to meet with you to decide what type of care should be provided to Mr. Warden. A 69–year-old daughter and a 64-year-old son , with two grandchildren, come to the meeting which also includes the physician in charge. After you introduce yourself and Dr. Hopson, Dr. Hopson explains their father’s condition and poor prognosis, you recommend no further treatment be given. The daughter becomes hysterical. Weeping and shouting, she states she wants “everything” done for her father. The son, on the other hand state he understand his father does not have a good quality of life and cannot communicate. “I don’t want him to suffer. Please give him comfort care only”. The daughter becomes more hysterical and accuses her brother of being cruel. The bother remains calm and repeats, “comfort care only”.
While you and Dr. Hopson attempt to address Mr. Warden’s quality of life issues and
the limited powers that medical care has over end of life care, the daughter shakes her head and continues to be agitated. At length, you ask her why she hasn’t visited her father in three years, despite the fact that she lives only a few miles away from the nursing home. The daughter ignores your question and continues to insist on a maximum level of medical care. She refuses to entertain the possibility of a do not resuscitate (DNR) order.
Her brother, however, agrees to the DNR and states “It’s not as if he’s there, really. Our father died a long time ago”. Upon further questioning, the son reveals he has the father’s power of attorney, and therefore has the authority to make the DNR decision in this case.
Modified from:
Buchbinder, S., Shanks, N., & Buchbinder, D. (2014).
Ethical Issues Over DNR Orders.Cases in